Recap of disc and standing MRI workshop and Brisbane vertigo.

Dr Geoff Harding is one of Australia’s leading Musculo-Skeletal medical practitioners and opened the event with a passionate well referenced presentation on his position on the importance of the disc as a pain generating structure.

Although there is a recent trend in the literature coming from the " pain science " approach that states that a lot of pain is due to neurological plasticity and other non structural causes Geoff made the argument that when your clinical assessment and your imaging both correlate, a structural diagnosis and treatment paradigm based on disc as a known pain generators still makes sense and should play an important role in your management plan.

Geoff went on to explain known referral patterns as shown by Professor Kellgren and gave a good synopsis of the types of disc pathologies, differentiating from a disc protrusion as well as looking at the histology and mechanisms of disc injury. He convincingly argued that depending of the study, disc injuries are still responsible for around 40% of your patients low back pain.

Dr David Proctor opened for the team at Bayside Standing MRI giving an overview of the differences between low field and high field MRI machines. Most of the MRI's currently operating in Australia are high field fixed machines running 1.5 to 3 Tesla. They are bulky, expensive to maintain due to the presence of liquid helium as a coolant and have the advantage of being very sensitive.

The new bread of machine and in David's opinion the future of MSK imaging in Australia is the low field machines.

Typically running strengths of 0.1 to 0.5 T they have the advantage of much lower maintenance and purchasing cost and also the added advantage of being small enough to allow upright imaging of the patient. Something that has always been an important consideration for clinicians trying to understand a weight bearing structure. Low field MRI machines are now selling around the $800,000 mark. Well within the budgets of imaging centers.

It was truly remarkable to see some of their case studies showing conditions such as a spondylolisthesis barely observable in the supine position but appearing as almost a grade 2 in the weight bearing MRI.

David did point out some of the limitations of the lower field machines such as the lacking the contract power needed for imaging of brains and more subtle areas such as the shoulder labrum. They are also unsuitable for obese patients with the sensititiy dropping after a patients weights over 100Kg which unfortunately is becoming a problem for Australian imaging centres (insert shameless plug for our NZ obesity eduventure)

Dr Peter Dunn also from Bayside Standing MRI began with a "MRI physics for dummies" pointing out if you understand some of the concepts of how the images are generated you are in a better position to understand some of the findings and limitations. It was also refreshing to hear that even experts in imaging still make the point that images are not a substitute for your clinical history and good examination.

The differences in a appearance of a Sponylolisthesis with standing MRI

Peter also went on to give a explanation of the link between disc herniation and nerve root impingement and also a really insightful summary of the Type 1,2, and 3 modic changes often associated with DJD.

David Proctor then closed on with some of fascinating cases that have been imaged in the clinic so far.

Dr Harding then returned closed the presentation by revisiting the art of the clinical exam.

Demonstrating some good ways of honing in on the tissues responsible for the pain generation as well as giving an overview of some of the treatment protocols that MSK Gp's may use such as injection of the interspinous ligament, trigger point stimulation and injection, epidurals and also made a good argument against the trend of too early aggressive rehab protocols and stated that short term rest should still play an important role in a patients recovery.

The AMSN would like to thank all the above speakers for their vast experience and insights into the future of MSK imaging.

For those that attended the events most of our presenters have got back to us with final notes. AMSN members can download them here.

Sunday 19th April 10am to 2pm Brisbane

The classification and management of Vertigo

Dr Rudi Gerdhardt was also back to usually passion which is the understanding, classification and treatment of Vertigo.

Again Rudi have an overview of the anatomy and physiology of the vestibular system and again made the point that is it vital to take a good history when a patient presents with symptoms of Vertigo. This allows the practitioner to try and ascertain if the vertigo is coming from a central or peripheral problem and also make a provisional diagnosis.

One of Rudi's clinical pearls is to ask the patient " What are you feeling without using the word dizzy ". This helps the practitioner get inside the head of the what the patient is actually experiencing. Its also worth not overlooking common factors such as stress and anxiety.

Rudi gave a good overview of the Dix-Halpike test and the Epley maneuver with refinements and explanations for both posterior and horizontal cannal problems and allowed for a lot more practical time as a development in his workshop style.

For those that missed it Rudi is presenting his Vertigo workshop again for the AMSN in Manly at the Harbord Diggers on May the 23rd. Early bird tickets are on sale for one more week.

Obesity Eduventure

Just a reminder for those that enrolled via our expressions of interest enrollment. There is now only 9 days left to be eligible to save a further $100 of the early price for this event.

We have secured an amazing deal of accommodation that can be viewed here.

Upcoming Fasica workshop on the 2nd of May

Just a reminder upcoming Fascia Wetlab on the 2nd of May is proving to be our best selling event for 2015 both for AHPRA and other the massage therapy events.

Vertigo Workshop in Manly 23rd May